Capitol Hill Report: AAN Fights for Threatened VA Epilepsy Centers

October 5, 2012

It recently came to our attention that the Veterans’ Administration (VA) is not inclined to include in its FY2014 budget request necessary funding for its Epilepsy Centers of Excellence (ECoE) that the AAN and the Epilepsy Foundation (EFA) worked hard to create in 2008. The legislation establishing the ECoE, authored in the 110th Congress by Sen. Patty Murray (D-WA) and Rep. Ed Perlmutter (D-CO), will “sunset” October 1, 2013, if the VA fails to fund the centers.

Last week, the AAN and the EFA initiated efforts to preserve this funding. All US AAN members were sent an action alert last Friday asking them to urge their US House member to sign a letter to persuade the VA to include funding for the ECoE in its FY 2014 budget request.

So far, the following members of the House have signed on:

Rep. Roscoe Bartlett (MD)

Rep. John Lewis (GA)

Rep. Leonard Boswell (IA)

Rep. G.K. Butterfield (NC)

Rep. Marcy Kaptur (OH)

Rep. Keith Ellison (MN)

Rep. Rick Larsen (WA)

Rep. Pete Stark (CA)

Rep. David McKinley (WV)

Rep. Jared Polis (CO)

Rep. Bruce Braley (IA)

If you haven’t sent your message yet, please send your message now as the sign-on deadline is October 10.

By all accounts the ECoEs have been a tremendous success. Prior to the creation of the centers, costs for epilepsy care had been increasing rapidly. By 2011, with the centers in place, VA costs for epilepsy care decreased by $5.5 million per year in real dollars. The centers are not only advancing the future of epilepsy care for soldiers, veterans and their families, but saving money.

Allowing the ECoE to sunset would jeopardize the significant progress that has been made and let several million dollars in infrastructure costs be lost.

The reason for the VA’s reluctance isn’t known for certain but we were told during the initial push for the legislation the VA doesn’t like to be told how to spend their money. When I discussed this last week with Sen. Murray, who is now chair of the Senate Veterans’ Affairs Committee, she was clearly disappointed and said it was typical of the VA to leave something out, knowing that the Congress would put it back in. We are working with Murray’s staff for a response from the Senate also.

We hope that our advocacy efforts will move the VA to include the ECoE in their budget request. If the VA does not, we will work with Sen. Murray and Rep. Perlmutter to reauthorize the centers and increase their appropriation in the next Congress.

AAN Targets CMS RAC Audit Approval

The AAN Medical Economics and Management Committee is developing a response to the Centers for Medicare & Medicaid Services (CMS), which recently approved the initiation of recovery audits for evaluation and management (E/M) services in physician offices, including CPT® code 99215.

Neurologists tend to bill higher level E/M codes, which mean that arbitrary RAC audits could be particularly damaging to AAN members. Not to mention that these audits target the population of providers who can least afford the time and cost it takes to appeal an audit.

The AAN response will indicate our strong opposition to RAC review of E/M codes and ask CMS to rescind its approval of these audits, specifically citing the reviews as inappropriate due to the variability and subjective nature of E/M coding. Including these codes will lead to audit decisions based on second guessing of physicians who apply complex decision-making based on the specific needs of each patient.

The audits will be conducted by Connolly, Inc., which is the Medicare contractor who conducts RAC audits in AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, Puerto Rico, and the US Virgin Islands.

The AAN has spoken out for several years in opposition to these arbitrary audits and that effort will continue.

The course, “Physician-led Advocacy: Creating Change,” will be directed by AAN Government Relations Committee Chair Elaine C. Jones, MD, FAAN, of Rhode Island. The program is Saturday, October 27, from 1:00 p.m. to 5:00 p.m., and offers 3.5 hours of CME.

I’ll be presenting part of the course, so come and talk some politics with me and your colleagues.